The objective of the proposed research is to assess and enhance colorectal cancer (CRC) screening delivery, utilization, and related outcomes within county health center primary care practices. The project is a collaborative effort between the Department of Preventive Medicine, SUNY at Stony Brook, and the Suffolk County Department of Health Services. The specific aim is to test an innovative approach to promoting CRC screening delivery and utilization within practices serving multiethnic, underprivileged populations, through an interacting continuing medical education (CME) provider intervention. The CME intervention is designed to improve providers' screening methods, CRC risk communication, behavioral counseling, and use of a systems approach to the delivery of clinical preventive services. Matched pairs of county health centers will be randomized into intervention or control practices for testing the CME intervention. Changes in recommendations and completion of screening will be evaluated using an audit of pre-post- intervention health center patient records. Pre-post- intervention surveys will be used to follow changes in provider knowledge, attitudes, and self-reported practices. The county computerized patient record/management system will be further developed for monitoring completion of CRC screening, including tracking procedures referred to specialty providers with established referral linkages. CRC risk assessment and communication and its role in improving patient decision-making among this population will be explored through a pilot evaluation. A pre-post- intervention telephone survey of a subset of randomly selected patients linked to health center providers will be conducted. This will examine the doctor-patient visit interaction and evaluate risk perception, risk counseling, and shared decision-making with respect to CRC test options and self-reported acceptability of screening methods and adverse events. The research will demonstrate the extent to which the implementation of organized approaches to CRC screening delivery influences screening utilization in primary care practices that serve multiethnic, underprivileged populations. The research focuses on important questions regarding factors influencing provider adoption of CRC guidelines and recommendations for CRC screening of such patients, as well as patient decisions to comply.